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1993, 04-16 Permit App: 93002582 Lawn Sprinkler SystemPLUMBING PERMIT APPLICATION FORM Information Worksheet ...JOB STREET ADDRESS: 32<(c Rhc CITY/STATE/ZIP: `-). OWNER: H - G25g2 MAILING ADDRESS: ,;-<' (Street) CONTRACTOR: ,L2 r - MAILING ADDRESS: ^ PARCEL NUMBER: PHONE NUMBER:"/ -)‘-2 15 6J7, (City/State') LICENSE NUMBER: PHONE NUMBER: (Zip) (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS SHOWERS KITCHEN SINKS !CLOTHS :•:•:••.•:.,:•••:•,:, • sHj GARBAGE DISPOSAL • • UTILITY SINKS • " : • 'KEW': FLOOR DRAINS BAR SINKS LAWN SPRINKLER — wow. *." • FOR EACH BACKFLOW DEVICE • WATER SOFTENER DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x6.00 = x 6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x6.00 x6.00 = x 6.00 = x6.00 = x6.00 x 6.00 = x 6.00 = x 6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = i . SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =s ,:',) c/(; Spokane County Division of Buildings